Medical Director MPO

Overview Aetna, a CVS Health company, offers a remote Medical Director (MPO) position. The role provides clinical expertise to promote high‑quality, patient‑focused medical care with emphasis on clinical and payment policy across commercial and Medicare environments. Responsibilities Conduct transactional reviews in support of the appeal process, clinical claim review, and predetermination of covered benefits. Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve quality and efficiency of health‑care services. Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests. Use data analysis proactively to identify opportunities for quality improvement and positively influence the delivery of quality care services. Serve as a subject matter expert, internal consultant, and payment policy contributor. Demonstrate the ability to work within and lead teams comprising a diverse group of health‑delivery professionals to manage business objectives. Collaborate effectively with functional areas. Qualifications Five (5) or more years of experience in health‑care delivery (e.g., clinical practice, health‑care industry). Active and current state medical license without encumbrances. M.D. or D.O., board certification in an ABMS‑recognized specialty with post‑graduate direct patient‑care experience. Preferred Qualifications Health‑plan/pay‑or experience. Foundational baseline skills in medicine, health policy, coding (HCPCS/CPT), clinical policy, reimbursement, and health‑care systems. Strong written and verbal communication skills. Pay Range Typical pay: $174,070.00 – $374,920.00 (base hourly rate or annual salary, dependent on experience, education, location, and other factors). The role also offers eligibility for bonus, commission, short‑term incentive, and an equity award program. Benefits The full‑time position includes a comprehensive benefits package that supports physical, emotional, and financial well‑being: medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources. Additional details are provided during the application process. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. #J-18808-Ljbffr 9025 CVS Shared Services Resources LLC